NPIMap

Organization Active NPI

Taylor Regional Medical Group LLC

  • Rural Health Clinic/Center
  • Campbellsville, KY
National Provider Identifier
1073370185
Registry record updated Sep 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TAYLOR REGIONAL MEDICAL GROUP LLC
Practice address
73 Kingswood Dr
Campbellsville, KY 42718-9604
Phone
(270) 849-2379
Fax
(270) 465-2126
NPI assigned
Mar 5, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Debra Waldron
Title
Credentialing Agent
Phone
(270) 465-3561

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

73 Kingswood Dr
Campbellsville, KY 42718-9604

Mailing address

1698 Old Lebanon Rd
Campbellsville, KY 42718-3319
Phone (270) 789-6087

Other names 1

  • TAYLOR REGIONAL HOSPITAL HEALTH CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240612002511 KY Part A Provider - Rural Health Clinic 4880616622 Practice locations: Campbellsville, KY
O20251212002113 KY Part B Supplier - Clinic/Group Practice 4880616622 Receives reassigned benefits from 9 practitioners
Practice locations: Campbellsville, KY

Rural health clinic certification: CCN 188573

Legal name
TAYLOR REGIONAL MEDICAL GROUP LLC
Doing business as
TAYLOR REGIONAL HOSPITAL HEALTH CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 27, 2025
Last certification
May 27, 2025
Ownership / control type
2B
Organization structure
LLCNon-profit
Incorporated
Oct 3, 2005 in KY
Enrollment address
73 Kingswood Dr
Campbellsville, KY 42718-9604
Related CCNs
180087

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D2298398Taylor Regional Rural Health Clinic73 Kingswood Dr, Campbellsville, KY 42718Certificate of waiverJan 31, 2028

National Provider Directory

National Provider Directory
Tax ID family
Taylor Regional Medical Groupllc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

Organizations that report the same tax identification number in the National Provider Directory.

View all 14

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

105B Greenbriar Dr
Campbellsville, KY 42718
Phone (270) 465-0632

111 Kingswood Dr
Campbellsville, KY 42718
Phone (270) 789-5822

219 Meader St
#J
Campbellsville, KY 42718
Phone (270) 789-3410

1862 Old Lebanon Rd
Campbellsville, KY 42718
Phone (270) 789-6175

1698 Old Lebanon Rd
#2A
Campbellsville, KY 42718
Phone (270) 789-0587

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shirley Buckner Individual Corporate DirectorBoard Chairman Jan 1, 2020
Taylor County Hospital District Health Facilities Corporation Organization, Campbellsville, KY Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2024
Operational/Managerial Control Apr 1, 2024
Damarco Richardson Individual Corporate DirectorBoard Member Jan 1, 2021
Amanda Hardin Individual W-2 Managing EmployeePhysician Practice Administra Feb 26, 2018
Michael L Everett Individual Corporate OfficerCeo Sep 5, 2023
Robert B Romines Individual Corporate DirectorBoard Treasurer Jan 1, 2023
Mary Cox Individual W-2 Managing EmployeeDirector of Physician Practic Apr 1, 2024
Donna Rice Hedgepath Individual Corporate DirectorBoard Member Jan 1, 2024
Kirby Smith Individual Corporate DirectorBoard Secretary Nov 19, 2022
William M Snapp Individual Corporate OfficerCfo Jul 5, 2022

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 99

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 99

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1709596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756857600000",
    "number": "1073370185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1698 OLD LEBANON RD",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427183319",
            "telephone_number": "270-789-6087",
            "fax_number": "270-789-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 KINGSWOOD DR",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427189604",
            "telephone_number": "270-849-2379",
            "fax_number": "270-465-2126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAYLOR REGIONAL MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-05",
        "last_updated": "2025-09-03",
        "certification_date": "2025-09-03",
        "status": "A",
        "authorized_official_last_name": "WALDRON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "CREDENTIALING AGENT",
        "authorized_official_telephone_number": "270-465-3561"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TAYLOR REGIONAL HOSPITAL HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TAYLOR REGIONAL HOSPITAL HEALTH CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Campbellsville, KY

Sources for this page

Verify at the official NPI Registry.